Improving Depression Care for Elders: Coordinating Center

This Was a Five-year Seven-site Trial to Study the Cost-effectiveness of a Population Based Disease Management Program for Late Life Depression in Primary Care.

Purpose: To determine the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment(IMPACT) collaborative care management program for late-life depression.

This study tested an organized method of delivering care for late life depression in primary care. Specifically, the investigators evaluated the effectiveness of this intervention as compared to 'care as usual'. The investigators studied the effect of the intervention on clinical outcomes such as depressive symptoms, functional status, health related quality of life. They also determined the cost-effectiveness of the intervention compared to care as usual.

Inclusion Criteria:

• Major depression or dysthymia as diagnosed by a structured diagnostic interview.
• Patient plans to receive primary care at the study clinic for the next year.

Exclusion Criteria:

• Age under 60.
• Current symptoms or history of psychosis or mania as determined by structured diagnostic interview.
• Cognitive impairment as defined by a score less than 23 on a Mini Mental Status Examination.
• Terminal illness - defined as having a life expectancy of less than 6 months.
• Active alcohol abuse as determined by a screening interview.
• High suicide risk as determined by current plan for suicide or a history of more than 3 prior suicide attempts in the past 10 years.