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Two Behavioral Interventions for Patients with Major Depression and Severe COPD
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A4886 - Two Behavioral Interventions for Patients with Major Depression and Severe COPD
Author Block: R. S. Novitch1, J. Sirey2, G. S. Alexopoulos2, Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, Division of Pulmonary Medicine, Albert Einstein College of Medicine, Department of Geriatric Psychiatry, Weill MedicalCollege of Cornell University; 1Burke Rehabilitation Hospital, White Plains, NY, United States, 2Department of Geriatric Psychiatry, Weill Medical College of Cornell University, White Plains, NY, United States.
Objective: Personalized Intervention for Depressed Patients with COPD (PID-C), a treatment mobilizing patients to participate in their care, was found more effective than usual care. To further improve its efficacy, we developed a Problem Solving-Adherence (PSA) intervention integrating problem solving into adherence enhancement procedures. We tested the hypothesis that PSA is more effective than PID-C in reducing depressive symptoms. Exploratory analyses sought to identify patients with distinct depressive symptom trajectories and compare their clinical profiles. Design: Randomized controlled trial.Setting: Acute inpatient rehabilitation and community.Participants: 101 diagnosed with COPD and major depression after screening 633 consecutive admissions for acute inpatient rehabilitation.Intervention: 14 sessions of PID-C vs. PSA over 26 weeks.Measurements: 24-item Hamilton Depression Rating Scale (HAM-D). Results: PSA was not more efficacious than PID-C in reducing depressive symptoms. Exploratory latent class growth modeling identified two distinct depressive symptoms trajectories. Unlike patients with unfavorable course (28%) who remained symptomatic, patients with favorable course (72%) had a decline of symptoms during the hospitalization followed by a milder decline after discharge. Patients with unfavorable course were younger, had greater scores in disability, anxiety, neuroticism, and dyspnea related limitation in activities and lower self-efficacy scores.Conclusions: Both interventions led to sustained improvement depressive symptoms. PID-C matches the skills of clinicians employed by community rehabilitation programs and can be integrated in the care of depressed COPD patients. Patients with severe disability, anxiety, neuroticism, and low self-efficacy are at risk for poor outcomes and in need of close follow-up and targeted interventions.
Author Block: R. S. Novitch1, J. Sirey2, G. S. Alexopoulos2, Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, Division of Pulmonary Medicine, Albert Einstein College of Medicine, Department of Geriatric Psychiatry, Weill MedicalCollege of Cornell University; 1Burke Rehabilitation Hospital, White Plains, NY, United States, 2Department of Geriatric Psychiatry, Weill Medical College of Cornell University, White Plains, NY, United States.
Objective: Personalized Intervention for Depressed Patients with COPD (PID-C), a treatment mobilizing patients to participate in their care, was found more effective than usual care. To further improve its efficacy, we developed a Problem Solving-Adherence (PSA) intervention integrating problem solving into adherence enhancement procedures. We tested the hypothesis that PSA is more effective than PID-C in reducing depressive symptoms. Exploratory analyses sought to identify patients with distinct depressive symptom trajectories and compare their clinical profiles. Design: Randomized controlled trial.Setting: Acute inpatient rehabilitation and community.Participants: 101 diagnosed with COPD and major depression after screening 633 consecutive admissions for acute inpatient rehabilitation.Intervention: 14 sessions of PID-C vs. PSA over 26 weeks.Measurements: 24-item Hamilton Depression Rating Scale (HAM-D). Results: PSA was not more efficacious than PID-C in reducing depressive symptoms. Exploratory latent class growth modeling identified two distinct depressive symptoms trajectories. Unlike patients with unfavorable course (28%) who remained symptomatic, patients with favorable course (72%) had a decline of symptoms during the hospitalization followed by a milder decline after discharge. Patients with unfavorable course were younger, had greater scores in disability, anxiety, neuroticism, and dyspnea related limitation in activities and lower self-efficacy scores.Conclusions: Both interventions led to sustained improvement depressive symptoms. PID-C matches the skills of clinicians employed by community rehabilitation programs and can be integrated in the care of depressed COPD patients. Patients with severe disability, anxiety, neuroticism, and low self-efficacy are at risk for poor outcomes and in need of close follow-up and targeted interventions.
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