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Effectiveness of Shared Decision-Making for Elderly Depressed Minority Primary Care Patients.

TitleEffectiveness of Shared Decision-Making for Elderly Depressed Minority Primary Care Patients.
Publication TypeJournal Article
Year of Publication2019
AuthorsRaue PJ, Schulberg HC, Bruce ML, Banerjee S, Artis A, Espejo M, Catalan I, Romero S
JournalAm J Geriatr Psychiatry
Volume27
Issue8
Pagination883-893
Date Published2019 Aug
ISSN1545-7214
Abstract

OBJECTIVE: The authors assessed the impact of a shared decision-making (SDM) intervention among elderly depressed minority primary care patients not currently receiving treatment.

METHODS: A total of 202 English and Spanish-speaking primary care participants aged 65 and older who scored positive on the Patient Health Questionnaire-9 (≥10) were randomized at the physician level to receive a brief SDM intervention or usual care (UC). Primary analyses focused on patient adherence to either psychotherapy or antidepressant medication, and reduction in depression severity (Hamilton Depression Rating Scale) over 12 weeks.

RESULTS: Patients randomized to physicians in the SDM condition were significantly more likely than patients of physicians randomized to UC to receive a mental health evaluation or initiate some form of treatment (39% versus 21%), and to adhere to psychotherapy visits over 12 weeks. There were no differences between groups in adherence to antidepressant medication or in reduction of depressive symptoms.

CONCLUSION: Among untreated elderly depressed minority patients from an inner-city municipal hospital, a brief SDM intervention was associated with greater initiation and adherence to psychotherapy. However, low treatment adherence rates across both groups and the intervention's lack of impact on clinical outcomes highlight the need to provide focused and accessible mental health services to patients choosing active treatments.

DOI10.1016/j.jagp.2019.02.016
Alternate JournalAm J Geriatr Psychiatry
PubMed ID30967321
PubMed Central IDPMC6646064
Grant ListR01 MH084872 / MH / NIMH NIH HHS / United States
Division: 
Biostatistics
Category: 
Faculty Publication